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Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility - King County, Washington, March 2020.
MMWR Morb Mortal Wkly Rep. 2020 Apr 03; 69(13):377-381.MM

Abstract

Older adults are susceptible to severe coronavirus disease 2019 (COVID-19) outcomes as a consequence of their age and, in some cases, underlying health conditions (1). A COVID-19 outbreak in a long-term care skilled nursing facility (SNF) in King County, Washington that was first identified on February 28, 2020, highlighted the potential for rapid spread among residents of these types of facilities (2). On March 1, a health care provider at a second long-term care skilled nursing facility (facility A) in King County, Washington, had a positive test result for SARS-CoV-2, the novel coronavirus that causes COVID-19, after working while symptomatic on February 26 and 28. By March 6, seven residents of this second facility were symptomatic and had positive test results for SARS-CoV-2. On March 13, CDC performed symptom assessments and SARS-CoV-2 testing for 76 (93%) of the 82 facility A residents to evaluate the utility of symptom screening for identification of COVID-19 in SNF residents. Residents were categorized as asymptomatic or symptomatic at the time of testing, based on the absence or presence of fever, cough, shortness of breath, or other symptoms on the day of testing or during the preceding 14 days. Among 23 (30%) residents with positive test results, 10 (43%) had symptoms on the date of testing, and 13 (57%) were asymptomatic. Seven days after testing, 10 of these 13 previously asymptomatic residents had developed symptoms and were recategorized as presymptomatic at the time of testing. The reverse transcription-polymerase chain reaction (RT-PCR) testing cycle threshold (Ct) values indicated large quantities of viral RNA in asymptomatic, presymptomatic, and symptomatic residents, suggesting the potential for transmission regardless of symptoms. Symptom-based screening in SNFs could fail to identify approximately half of residents with COVID-19. Long-term care facilities should take proactive steps to prevent introduction of SARS-CoV-2 (3). Once a confirmed case is identified in an SNF, all residents should be placed on isolation precautions if possible (3), with considerations for extended use or reuse of personal protective equipment (PPE) as needed (4).

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

32240128

Citation

Kimball, Anne, et al. "Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility - King County, Washington, March 2020." MMWR. Morbidity and Mortality Weekly Report, vol. 69, no. 13, 2020, pp. 377-381.
Kimball A, Hatfield KM, Arons M, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility - King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep. 2020;69(13):377-381.
Kimball, A., Hatfield, K. M., Arons, M., James, A., Taylor, J., Spicer, K., Bardossy, A. C., Oakley, L. P., Tanwar, S., Chisty, Z., Bell, J. M., Methner, M., Harney, J., Jacobs, J. R., Carlson, C. M., McLaughlin, H. P., Stone, N., Clark, S., Brostrom-Smith, C., ... Jernigan, J. A. (2020). Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility - King County, Washington, March 2020. MMWR. Morbidity and Mortality Weekly Report, 69(13), 377-381. https://doi.org/10.15585/mmwr.mm6913e1
Kimball A, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility - King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr 3;69(13):377-381. PubMed PMID: 32240128.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility - King County, Washington, March 2020. AU - Kimball,Anne, AU - Hatfield,Kelly M, AU - Arons,Melissa, AU - James,Allison, AU - Taylor,Joanne, AU - Spicer,Kevin, AU - Bardossy,Ana C, AU - Oakley,Lisa P, AU - Tanwar,Sukarma, AU - Chisty,Zeshan, AU - Bell,Jeneita M, AU - Methner,Mark, AU - Harney,Josh, AU - Jacobs,Jesica R, AU - Carlson,Christina M, AU - McLaughlin,Heather P, AU - Stone,Nimalie, AU - Clark,Shauna, AU - Brostrom-Smith,Claire, AU - Page,Libby C, AU - Kay,Meagan, AU - Lewis,James, AU - Russell,Denny, AU - Hiatt,Brian, AU - Gant,Jessica, AU - Duchin,Jeffrey S, AU - Clark,Thomas A, AU - Honein,Margaret A, AU - Reddy,Sujan C, AU - Jernigan,John A, AU - ,, AU - ,, Y1 - 2020/04/03/ PY - 2020/4/3/entrez PY - 2020/4/3/pubmed PY - 2020/4/9/medline SP - 377 EP - 381 JF - MMWR. Morbidity and mortality weekly report JO - MMWR Morb. Mortal. Wkly. Rep. VL - 69 IS - 13 N2 - Older adults are susceptible to severe coronavirus disease 2019 (COVID-19) outcomes as a consequence of their age and, in some cases, underlying health conditions (1). A COVID-19 outbreak in a long-term care skilled nursing facility (SNF) in King County, Washington that was first identified on February 28, 2020, highlighted the potential for rapid spread among residents of these types of facilities (2). On March 1, a health care provider at a second long-term care skilled nursing facility (facility A) in King County, Washington, had a positive test result for SARS-CoV-2, the novel coronavirus that causes COVID-19, after working while symptomatic on February 26 and 28. By March 6, seven residents of this second facility were symptomatic and had positive test results for SARS-CoV-2. On March 13, CDC performed symptom assessments and SARS-CoV-2 testing for 76 (93%) of the 82 facility A residents to evaluate the utility of symptom screening for identification of COVID-19 in SNF residents. Residents were categorized as asymptomatic or symptomatic at the time of testing, based on the absence or presence of fever, cough, shortness of breath, or other symptoms on the day of testing or during the preceding 14 days. Among 23 (30%) residents with positive test results, 10 (43%) had symptoms on the date of testing, and 13 (57%) were asymptomatic. Seven days after testing, 10 of these 13 previously asymptomatic residents had developed symptoms and were recategorized as presymptomatic at the time of testing. The reverse transcription-polymerase chain reaction (RT-PCR) testing cycle threshold (Ct) values indicated large quantities of viral RNA in asymptomatic, presymptomatic, and symptomatic residents, suggesting the potential for transmission regardless of symptoms. Symptom-based screening in SNFs could fail to identify approximately half of residents with COVID-19. Long-term care facilities should take proactive steps to prevent introduction of SARS-CoV-2 (3). Once a confirmed case is identified in an SNF, all residents should be placed on isolation precautions if possible (3), with considerations for extended use or reuse of personal protective equipment (PPE) as needed (4). SN - 1545-861X UR - https://www.unboundmedicine.com/medline/citation/32240128/Asymptomatic_and_Presymptomatic_SARS_CoV_2_Infections_in_Residents_of_a_Long_Term_Care_Skilled_Nursing_Facility___King_County_Washington_March_2020_ L2 - https://doi.org/10.15585/mmwr.mm6913e1 DB - PRIME DP - Unbound Medicine ER -